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| Name | Class |
|---|---|
| FormusLab | UNKNOWN |
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Accurate reconstruction of the native hip parameters following total hip arthroplasty is associated with improved outcome. In order to improve ability for optimum reconstruction, 3-D templating software can be utilized that provide detailed information regarding native anatomy. In order to achieve reconstruction within acceptable parameters as per pre-operative plan, some surgeons propose the use of intra-operative devices that measure component orientation and joint reconstruction ("Measured-THA"), whilst others propose the use of navigation tools ("Navigation-THA). Both techniques have shown superiority compared to the most commonly used "freehand" technique, but no prior study has assessed for superiority between these 2 techniques. Furthermore, to-date assessment of post-operative reconstruction has not been tested in detail as post-THA assessments are based on radiographs which provide incomplete, 2-dimensional, assessments and are lacking the important axial plane reconstruction parameters. The aims of this prospective, randomized, trial are to 1. appraise the ability to achieve the pre-operative 3-D plan (as per FormusLab) through a comparison of pre-op plan to post-operative reconstruction; 2. compare ability to accurately reconstruct hip following THA between "navigated-" (IntelliJoint®) and "measured-" techniques; and in doing so it will also 3. assess the accuracy of the intra-operative assessments of reconstruction through a comparison of objective (i.e. measured) intra-operative assessments with the post-operative reconstructions achieved.
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| Label | Type | Description | Intervention Names |
|---|---|---|---|
| Measured Technique | Experimental | Patients in this group will have pre-operative planning done using the measured technique. |
|
| Navigated Technique | Experimental | Patients in this group will have pre-operative planning done using the navigated technique. |
|
| Name | Type | Description | Arm Group Labels | Other Names |
|---|---|---|---|---|
| Measured Technique | Procedure | Manual intra-operative checks and tools are used to aid in component placement during surgery. |
|
| Measure | Description | Time Frame |
|---|---|---|
| Change in Pain Assessment - Oxford Hip Score | The Oxford Hip Score will be given to patients to assess subjective measures of hip pain. Scores for each question from 0 to 4 with 4 being the best outcome. This method, when summed, produces overall scores running from 0 to 48 with 48 being the best outcome | once pre-operatively and once one-year post-operatively |
| Change in mobility, self-care, usual activities, pain/discomfort and anxiety/depression- EuroQol | the EuroQol (EQ-5D-5L) will be given to patients to assess subjective measures mobility, self-care, usual activities, pain/discomfort and anxiety/depression. Each dimension in the EQ-5D-5L has five response levels: no problems (Level 1); slight; moderate; severe; and extreme problems (Level 5). The maximum score of 1 indicates the best health state, by contrast with the scores of individual questions, where higher scores indicate more severe or frequent problems. | once pre-operatively and once one-year post-operatively |
| Change in physical, mental, and social health- PROMIS Global-10 | the PROMIS Global-10 will be given to patients to assess subjective measures of physical, mental and social health. It is a 10-item patient-reported questionnaire in which the response options are presented as 5-point (as well as a single 11-point) rating scales. The results of the questions are used to calculate two summary scores: a Global Physical Health Score and a Global Mental Health score. Higher scores indicate worse physical and mental health | once pre-operatively and once one-year post-operatively |
| Adverse Events | Serious adverse events will be monitored. This includes:
| 90 days post-operatively |
| Measure | Description | Time Frame |
|---|---|---|
| Accuracy of reconstruction (in mm) | A measure (in mm) of how close the planned to actual reconstruction using the aforementioned reconstruction parameters. This will be assessed using:
|
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Exclusion Criteria:
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| Name | Role | Phone | Extension | |
|---|---|---|---|---|
| Isabel Horton | Contact | 613-737-8899 | 73032 | ihorton@ohri.ca |
| Name | Affiliation | Role |
|---|---|---|
| George Grammatopoulos, MD | The Ottawa Hospital | Principal Investigator |
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| PubMed Identifier | Type | Citation | Retractions |
|---|---|---|---|
| 33840537 | Background | Fang CJ, Shaker JM, Ward DM, Jawa A, Mattingly DA, Smith EL. Financial Burden of Revision Hip and Knee Arthroplasty at an Orthopedic Specialty Hospital: Higher Costs and Unequal Reimbursements. J Arthroplasty. 2021 Aug;36(8):2680-2684. doi: 10.1016/j.arth.2021.03.044. Epub 2021 Mar 23. | |
| 33869155 | Background |
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| ID | Term |
|---|---|
| D015207 | Osteoarthritis, Hip |
| ID | Term |
|---|---|
| D010003 | Osteoarthritis |
| D001168 | Arthritis |
| D007592 | Joint Diseases |
| D009140 | Musculoskeletal Diseases |
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| Navigated Technique | Procedure | IntelliJoint® navigation is an imageless-based navigation system that utilizes a miniature infrared camera and microelectronics to measure hip center of rotation, acetabular inclination and version, leg length, and offset. The device provides accurate real-time data on implant positioning to aid in placement of the components during surgery. |
|
| post-operatively (within one week post-operatively) |
| Comparison of margin of error | This outcome will measure what the margin of error is between intra-operatively measured values and those determined from the post-operative CT scan. This will be done using statistical analysis of data for patients in both study arms. | Through study completion, an average of 1 year |
| Accuracy of reconstruction on outcome | This outcome measure will assess the accuracy of reconstruction correlate with outcome (adverse events and PROMs). This will be done by analyzing accuracy as depicted by the variables in outcome measure 5, and how these measures of accuracy correlate to patient reported outcome measure scores and rates of adverse events | Through study completion, an average of 1 year |
| Accuracy of reconstruction (in degrees) | A measure (in degrees) of how close the planned to actual reconstruction using the aforementioned reconstruction parameters. This will be assessed using: Acetabular component orientation (Radiographic inclination/anteversion in degrees as per Murray)
| post-operatively (within one week post-operatively) |
| Hu X, Zheng N, Chen Y, Dai K, Dimitriou D, Li H, Tsai TY. Optimizing the Femoral Offset for Restoring Physiological Hip Muscle Function in Patients With Total Hip Arthroplasty. Front Bioeng Biotechnol. 2021 Mar 30;9:645019. doi: 10.3389/fbioe.2021.645019. eCollection 2021. |
| 25628277 | Background | Grammatopoulos G, Thomas GE, Pandit H, Beard DJ, Gill HS, Murray DW. The effect of orientation of the acetabular component on outcome following total hip arthroplasty with small diameter hard-on-soft bearings. Bone Joint J. 2015 Feb;97-B(2):164-72. doi: 10.1302/0301-620X.97B2.34294. |
| 34143758 | Background | Agarwal S, Eckhard L, Walter WL, Peng A, Hatton A, Donnelly B, de Steiger R. The Use of Computer Navigation in Total Hip Arthroplasty Is Associated with a Reduced Rate of Revision for Dislocation: A Study of 6,912 Navigated THA Procedures from the Australian Orthopaedic Association National Joint Replacement Registry. J Bone Joint Surg Am. 2021 Oct 20;103(20):1900-1905. doi: 10.2106/JBJS.20.00950. |
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| 31506002 | Background | Kievit AJ, Dobbe JGG, Mallee WH, Blankevoort L, Streekstra GJ, Schafroth MU. Accuracy of cup placement in total hip arthroplasty by means of a mechanical positioning device: a comprehensive cadaveric 3d analysis of 16 specimens. Hip Int. 2021 Jan;31(1):58-65. doi: 10.1177/1120700019874822. Epub 2019 Sep 11. |
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| 28887022 | Background | Innmann MM, Maier MW, Streit MR, Grammatopoulos G, Bruckner T, Gotterbarm T, Merle C. Additive Influence of Hip Offset and Leg Length Reconstruction on Postoperative Improvement in Clinical Outcome After Total Hip Arthroplasty. J Arthroplasty. 2018 Jan;33(1):156-161. doi: 10.1016/j.arth.2017.08.007. Epub 2017 Aug 12. |
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| 19837559 | Background | Minoda Y, Ohzono K, Aihara M, Umeda N, Tomita M, Hayakawa K. Are acetabular component alignment guides for total hip arthroplasty accurate? J Arthroplasty. 2010 Sep;25(6):986-9. doi: 10.1016/j.arth.2009.07.016. Epub 2009 Oct 17. |
| 26733639 | Background | Beverland DE, O'Neill CK, Rutherford M, Molloy D, Hill JC. Placement of the acetabular component. Bone Joint J. 2016 Jan;98-B(1 Suppl A):37-43. doi: 10.1302/0301-620X.98B1.36343. |
| 22865253 | Background | Bonnin MP, Archbold PH, Basiglini L, Fessy MH, Beverland DE. Do we medialise the hip centre of rotation in total hip arthroplasty? Influence of acetabular offset and surgical technique. Hip Int. 2012 Jul-Aug;22(4):371-8. doi: 10.5301/HIP.2012.9350. |
| 31122846 | Background | Merle C, Innmann MM, Waldstein W, Pegg EC, Aldinger PR, Gill HS, Murray DW, Grammatopoulos G. High Variability of Acetabular Offset in Primary Hip Osteoarthritis Influences Acetabular Reaming-A Computed Tomography-Based Anatomic Study. J Arthroplasty. 2019 Aug;34(8):1808-1814. doi: 10.1016/j.arth.2019.03.065. Epub 2019 Apr 1. |
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| 29458202 | Background | Lee YK, Kim JW, Kim TY, Ha YC, Koo KH. Validity of the intra-operative measurement of stem anteversion and factors for the erroneous estimation in cementless total hip arthroplasty using postero-lateral approach. Orthop Traumatol Surg Res. 2018 May;104(3):341-346. doi: 10.1016/j.otsr.2017.11.023. Epub 2018 Feb 16. |
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| Background | Gross AE, Safir OA, Kuzyk PRT, Sculco PK, Wolfstadt J, Girardi BL, et al. Optimizing leg length and cup position: A surgical navigation tool. Seminars in Arthroplasty. 2018;29(3):157-60. |
| D012216 |
| Rheumatic Diseases |